IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Kolkata
Award Ref: CIO/ANDAMAN-AND-NICOBAR-UT/2024
Andaman & Nicobar Hospital Billing & Health Insurance Dispute Guide
Statutory Protections, Insurance Ombudsman Jurisdiction & Hospital Recovery across Andaman & Nicobar
Total Hospital Billed
₹250,000
Arbitrary TPA Cut
₹48,500
Legally Recoverable
₹48,500
Deterministic Math Comparison: TPA Cut vs. IRDAI May 2024 Statutory Math
| Line Item / Disputed Component | Billed (₹) | TPA Cut (₹) | Statutory Approved (₹) | Recoverable Overcharge (₹) | IRDAI Statutory Reference |
|---|---|---|---|---|---|
| State Average Titanium Joint / Stent Cut | ₹115,000 | ₹26,000 | ₹115,000 | ₹26,000 | Clause 19 Protection |
| State Average OT Consumables Slashed | ₹22,000 | ₹13,000 | ₹22,000 | ₹13,000 | Annexure-1 Allow-List |
Verbatim IRDAI Circulars & Statutory Citations
State CIO Jurisdiction — Kolkata
Adjudicates claims under Insurance Ombudsman Rules 2017.
Citation: Ministry of Finance Gazette Notification
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Where can I file an insurance complaint against unfair deductions in Andaman & Nicobar?
Policyholders in Andaman & Nicobar can escalate unresolved deductions to the Insurance Ombudsman Centre in Kolkata or lodge an electronic complaint on Bima Bharosa.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Kolkata)
Address: Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, Kolkata - 700072
States & UTs Covered: West Bengal, Sikkim, Andaman & Nicobar